Methadone Maintenance Treatment (MMT) in General Practice or in Specialized Centers: Profile of Patients in the Swiss Canton of Vaud

Abstract

We studied profile of patients (n=1782) treated in specialized centers and general practice (GP) enrolled in methadone maintenance treatment (MMT) programs during 2001 in the Swiss Canton of Vaud. We found that GPs treated the majority of patients (76%). Specialized centers treated a higher proportion of patients with uncontrolled intravenous use of cocaine and heroin, and prescribed neuroleptics as concomitant medication three times more frequently than GPs. Patients treated in specialized centers were more likely to undergo screening for HIV, HBV, HCV, and receive complete HBV immunization. In conclusion, specialized centers are more likely to treat severely addicted patients and patients with a poor global assessment (physical, psychiatric, and social).

Opiate addiction and overdose: experiences, attitudes, and appetite for community naloxone provision

“…35 In Scotland, 44% of GPs were providing methadone in 2008, 36 while in some regions of Switzerland, GPs are known to provide most opiate substitution treatment. 37 Research from England and Wales suggests that over time an increasing number of GPs have become involved in opiate substitution treatment; however, more patients with opiate use disorder are seen for general medical care than are prescribed methadone by their GP. 38 This observation suggests a discrepancy between exposure to opiate use disorder in general practice and the discipline's capacity or willingness to provide opiate substitution treatment and possibly overdose education, prevention, and treatment in the community.…”

Office-Based Treatment in Opioid Dependence: A Critical Survey of Prescription Practices for Opioid Maintenance Medications and Concomitant Benzodiazepines in Vienna, Austria

“…This system continues to be quite successful and has been shown to produce patient outcomes comparable to those seen in specialized treatment [1,[3][4][5][6][7][8] . It also helps to reduce barriers to treatment in terms of geography and stigmas in the health care system, both of which are reduced through the mainstreaming of treatment [3,4,8] . However, GPs often lack sufficient training to properly treat opioid addiction, and problems with burnout, stigma and lack of motivation have been reported [3,8,10,11] .…”

“…It also helps to reduce barriers to treatment in terms of geography and stigmas in the health care system, both of which are reduced through the mainstreaming of treatment [3,4,8] . However, GPs often lack sufficient training to properly treat opioid addiction, and problems with burnout, stigma and lack of motivation have been reported [3,8,10,11] . Here, we look at records of maintenance prescriptions written by GPs to quantify the number of patients being treated in this setting in 2002 and 2005.…”

“…The European model of treatment coverage, seen in Austria, France and Switzerland, for instance, relies heavily on office-based treatment: most patients are treated in office-based settings by GPs plus a small number of specialized clinics, which provide both maintenance treatment and additional therapeutic services, especially for patients with comorbidities [8,9] . This system continues to be quite successful and has been shown to produce patient outcomes comparable to those seen in specialized treatment [1,[3][4][5][6][7][8] .…”

Clinical Characteristics of Central European and North American Samples of Pregnant Women Screened for Opioid Agonist Treatment

“…In addition, particularly for patients with comorbidities, there are only a small number of specialized clinics which provide both maintenance treatment and additional therapeutic services [23][24][25] . This system has been shown to produce patient outcomes comparable to those seen in specialized treatment, and it continues to be quite successful [25,26] .…”